PATHOPHYSIOLOGY Week 3 Inflammation, Dysfunctional Healing, …

PATHOPHYSIOLOGY Week 3 Inflammation, Dysfunctional Healing, and Immune DisordersCase study:Scenario 1:Kevin is a 58-year-old mechanic living in rural Arizona. While repairing a vehicle, he sustains a left forearm laceration from a dirty, sharp piece of metal from within the vehicle. The 5 cm (2 inch) wound bled initially. Kevin rinsed off his wound and bandaged it with gauze. Three days following the injury, Kevin begins to notice surrounding redness, warmth, swelling, and pain to the wound. The laceration is also oozing bloodstained pus onto the gauze.Kevin decides to visit an urgent care clinic where he is diagnosed with cellulitis of the left forearm. At the clinic, he is advised to elevate it through the night as well as clean and re-bandage the wound 2x/day. He has been prescribed cephalexin QID for the cellulitis.VS: Temp: 36.9?C, HR: 70, BP: 130/85, O2Sat: 97%Focused Exam: Kevin appears well. Left forearm has a 5 cm (2 inch) laceration healing by 2?/3? intention with surrounding redness, warmth, and tenderness to palpation. There is obvious swelling to the forearm. No lymphangitis or axillary discomfort.1) Briefly discuss the term cellulitis.
2) Discuss the components of Kevin’s innate immune system.
3) Discuss the phases of the inflammatory response. (vascular, cellular, systemic) What is opsonisation and how does it relate to the compliment system?
4) Briefly discuss how the adaptive immune system differs from his innate immune system. (B & T lymphocytes; delayed, specific, and long- term memory)5) What circumstances can activate acute inflammation?6) Briefly describe the various types of white blood cells (WBC). (neutrophils, lymphocytes, monocytes, basophils, eosinophils) (Identify: a) where are they produced, b) their primary function) What are bands in the blood?
Scenario 1 – continued:Two days following his urgent care visit, Kevin again decides to seek medical attention because he is concerned about increasing swelling and redness to his left arm. Moreover, he has been unable to work for the past day due to severe pain with movements of his arm.He describes feeling chilled, flushed, with loss of appetite since yesterday. He now complains of tenderness in his left axilla upon palpation.VS: Temp: 38.8?C (101.8?F), HR: 110, BP: 115/88, O2Sat: 97%Blood Work: CBC/diff: WBC (white blood cell count): 16,000/ml [90% neutrophils]Haemoglobin: 12.5 g/dLPlatelets: 450,000/mlBands: 11%ESR & CRP: elevatedX-ray: metallic object in soft tissue of left forearm1) Why is Kevin’s arm progressively worsening? Discuss other potential reasons for his worsening condition.2) Discuss the systemic phase of acute inflammation. Does Kevin have signs of this phase?3) Review the vital signs and blood tests. Does Kevin have SIRS? Sepsis? Why is sepsis so important to consider?4) Discuss the potential outcomes of Kevin’s left arm acute inflammation?5) Explain how acute and chronic inflammations differ. Provide examples of chronic inflammation.6) What immunization should Kevin be offered if a booster is required?7) Discuss the phases of tissue healing following an injury?
Scenario 2:A 7-year-old girl, Jasmine, is taken to a medical clinic with high fevers, red eyes, coughing, and a runny nose. The child is covered with a rash that started on his face then quickly spreads to her entire body. Jasmine has never received any immunizations in the past due to parental concerns regarding immunization.VS: Temp: 40.5?C, HR: 140, RR: 26, O2Sat: 96%Physical Exam: – Ill-appearing child, with dry mucous membranes– Obvious coughing with shortness of breath-Eyes – bright, red, inflamed-Koplik spots of oral mucosa-Swollen cervical (neck) lymph nodesCBC: WBC: 21,000/mm3, Hg: 17.5 g/dL, Platelets: 300,000/?l
?? Briefly discuss the child’s condition. What is the main function of the immune system??? Review where:?? WBCs are produced and mature in the body.?? What is Leukocytosis and Leukopenia? Why do we care??? Briefly review the 5 types of WBCs and their primary functiond) Discuss the 3 different cell lines produced in the bone marrow (hematopoiesis).?? What is the body’s humoral immunity response to a new infection?
?? Discuss other antibody types in the body. (GAMED)?? What is a serum Antibody Titer? What is its purpose??? Describe the difference between the primary antibody response to a microbe and the Secondary antibody (amnestic response) response to a microbe using IgM and IgG.4) Discuss the types of immunity a person can have or acquire.A) Passive natural immunity?B) Passive artificial immunity?C) Active natural immunity?D) Active artificial immunity??? Review why Jasmine’s WBC count is 21,000.?? Review the diverse types of vaccinations/inoculations
Scenario 3:Tamiko, a patient with ESRD (end stage renal disease), has been selected for a renal transplant. Tamiko is currently in hospital preparing for the transplant. She has received her initial dose of Basiliximab for immunosuppression.?? Discuss the body’s ability to recognize “self” from “non-self.”?? Which part of the immune system is most involved in organ rejection??? Why are immunosuppressants always required for organ transplants? (one exception)?? What will happen if non-adherence to medications occurs? [review hyper-acute, acute, chronic rejection]?? Discuss Autologous vs. Allogenic transplants. How do they differ?
Scenario 4:A 19-year-old woman, Alisha, is hiking with a friend when a wasp stings her lower leg. Within minutes, Alisha feels itchy, her lips begin to swell, and she experiences shortness of breath. A red rash has also diffusely covered her body.By the time Alisha arrives at the hospital ER, she presents with a head-to-toe urticarial (itchy) rash, swollen lips, face and ears. She is feeling anxious and short of breath with wheezing, she has pale skin, poor capillary refill, but not cyanotic.PMHx: noneMedications: noneVS: HR: 130, RR: 26, BP: 72/40, O2Sat: 86%1) Discuss the most likely condition causing Alisha’s symptoms and discuss the underlying pathophysiology. (Reference picture at end of document)2) Discuss the common manifestation (signs and symptoms) of this condition.What are the priority actions of the healthcare team member?3) What other kinds of allergens can cause this severe systemic reaction?4) Briefly review the 4 types of hypersensitivity reactions:Type 1:Type 2:Type 3:Type 4:
5) This condition is life threatening. Why? What is the immediate treatment?
Scenario 5:A 9-year-old girl, Amanda, is brought to the hospital with a cough, shortness of breath, and occasional wheezing. Her symptoms began 2 days ago and have progressed in severity with any exertion or activity. Amanda is otherwise a healthy girl.Presentation at hospital: Well-appearing child with a cough and audible wheezingPMHx: noneMedications: noneFamily Hx: Mother: Rheumatoid arthritis Brother : Diagnosed with asthma1) What is the likely condition and briefly discuss the pathophysiology? How does her family history play a role?2) Provide examples of other conditions that are considered auto-immune.3) What are the basic underlying processes and possible triggers of these conditions?4) Briefly discuss the approach to treating autoimmune conditions.
5) How would Amanda be treated for her condition?
Scenario 6:A 44-year-old male, Nick, presents with white plaques on his pharynx and painful swallowing, plus gradual weight loss and weakness over the past 6 months. He also mentions a persistent cough and SOB for the past 3 months which hasn’t been treated.PMHx: – hepatitis C from previous IV drug use– appendectomy as a child– MVC (motor vehicle collision) requiring blood transfusions 8 years agoMedications: noneSocial History: – denies current IV drug useFocused Exam: – Generally appears thinThroat: white plaques consistent with oral candidiasisRespiratory: bilateral crepitations / crackles to lungs on inspirationSkin: multiple raised purple lesions to chest and legs1) What underlying illness is this patient likely presenting with? What symptoms/signs/history suggest this condition in Nick?2) Discuss the pathophysiology of this illness.3) Review all the potential ways a patient can acquire this disease.4) Discuss the 3 stages of HIV infection5) How do we test for this disease? What information does a viral load and a CD4 count tell us?6) What will likely occur to the patient if the disease progresses? What is the term opportunistic infection/malignancies?7) Briefly discuss why HIV is considered a chronic disease Plagiarism Free Papers
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